Help for heartburn

Endoscopic surgery may eliminate the need for risky drugs

Kathy Halsey
suffered foot and
arm bone fractures
while taking GERD
medications.
However, after
a nonsurgical
procedure, she
was able to go off
the drugs.

About five years ago Kathy Halsey, a school administrator, decided she
had to do something about the nagging chronic heartburn and reflux
that had plagued her for years.

“The burning and pain would happen
all day, making it hard to work. I had to eat right before any meeting
and take drugs every day just to get my job done, and I would still have
unbearable burning, and then headaches associated with acid reflux. At night,
I had to sleep sitting up. My quality of life was severely reduced.”

Officially Halsey had gastroesophageal reflux disease, or GERD, a painful
condition whereby stomach acid or stomach content flows back into the
esophagus. GERD, which is more common as we age, is usually due to a
faulty sphincter valve between the stomach and esophagus.

But doing something about her case of GERD proved more challenging
than Halsey expected. Over the years, the most common medications to treat
the condition, proton pump inhibitors (PPIs), have been linked to a growing
list of serious side effects, such as pneumonia, kidney disease, bone fractures
and dementia. And recently several studies have found that people taking PPIs
are at increased risk for heart attack, stroke and renal failure, possibly because
the lining of cardiovascular blood vessels is impaired by the drugs.

Those side effects make it more important
than ever for patients to consider alternative
treatments for GERD, including a number of
options offered by UC Irvine Health experts, using
endoscopy, a nonsurgical technique that accesses
the digestive tract through the mouth.

Dr. Kenneth Chang

“Because we’re learning so much about the
possible negative side effects of long-term
use of PPIs, I see a dramatic shift away from
people taking those drugs and toward getting
these sorts of endoscopic treatments,” says Dr.
Kenneth Chang, director of the UC Irvine Health H.H. Chao Comprehensive
Digestive Disease Center (CDDC) and a leading specialist in GERD, Barrett’s
esophagus and endoscopic surgery to treat digestive disease.

But many patients, like Halsey, try over-the-counter PPIs first. She
didn’t smoke, didn’t drink excessively, changed her diet and controlled her
weight — all first-line lifestyle treatments for GERD. But absolutely nothing
stopped the reflux. Then tests revealed she had Barrett’s esophagus, a
precancerous condition often associated with chronic GERD.

“That’s when it all got very serious,” Halsey says. She was advised by her
gastroenterologist to take various prescription PPIs, such as Dexilant™,
Nexium™, Prevacid™ and Prilosec™. Prescription PPIs are more potent than the
over-the-counter versions. The medications have become so common that
nearly 16 percent of adults ages 55 to 64 take them; only cardiac and cholesterol
drugs are more common. For some patients, the medication benefits still
outweigh the risks. For Halsey, however, PPIs weren’t a good solution.

“For three years I worked with my first gastroenterologist, taking different
prescription medications to stop the acid, I also started breaking bones,”
says Halsey, who fractured both her foot and arm. “I’d never broken a bone
in my entire life, so of course I was really concerned.”

The next step for her would’ve been an invasive surgery to treat the
esophagus and the faulty valve. Her gastroenterologist told her that the
only doctor in Southern California who could help her with other options
was Dr. Chang.

“Kathy was the perfect candidate for an EsophyX TIF™ procedure, which
is something that we offer here but isn’t available yet in many places,”
says Chang. An EsophyX TIF™ — which stands for transoral incisionless
fundoplication — is a surgery performed using a special scope and camera
inserted through the mouth. First, in a separate procedure, Chang removed
Halsey’s precancerous cells. After restoring the cells to normal, he treated
the underlying GERD with the EsophyX TIF™ procedure, restoring proper
function by elongating the esophagus and tightening the sphincter valve to
keep stomach acid from splashing up.

An EsophyX TIF™ is done under anesthesia and takes only about an hour.
Patients spend one night in the hospital and resume work and other activities
in a couple of days. About 75 percent of these patients no longer need PPIs.

CDDC physicians also offer other techniques to treat various types of
GERD. The LINX procedure involves endoscopically implanting a special
magnetic ring around the esophagus, just above the stomach. The magnetic
ring strengthens the function of the sphincter. Swallowing breaks the
magnetic bond so food and liquid pass normally into the stomach. After
swallowing, magnetic attraction brings the beads back together to prevent
stomach acid and contents from splashing back into the esophagus.

A procedure called Stretta™ involves endoscopically administering
radiofrequency energy to a patient’s sphincter to bulk it up and increase its
effectiveness. “Stretta is ideal for people with a rather mild form of GERD,
usually those who only have reflux during the day,” says Chang. These
procedures, like the EsophyX TIF™, allow patients to drastically reduce or,
more often, totally eliminate medications.

Another new minimally invasive GERD treatment to reinforce the
sphincter is called MUSE™, which stands for the Medigus Ultrasonic
Surgical Endostapler. The system utilizes a single instrument that’s inserted
through the mouth to allow surgeons to repair the sphincter. The procedure,
performed under general anesthesia, takes about 60 to 90 minutes and
provides relief from GERD.

“To me, the EsophyX™ procedure was a miracle,” says Halsey, who now
has no battles with reflux and instead enjoys traveling, Pilates classes and
meditation. “Here was a condition I suffered with for so many years and
I had taken all those medications. Dr. Chang basically fixed it with this
minimally invasive procedure. Dr. Chang gave me back my quality of life
and, more importantly, saved my life.”